The more we learn about ADHD and eating disorders, the more we are coming to understand that the incidence of ADHD is actually higher in the eating disorder population and is not just eating disorders “looking like” ADHD. Something is happening here that warrants further understanding and exploration of how we approach eating disorder treatment when this comorbidity is present. 

There are biological, cognitive, and behavioral patterns inherent in both that can influence the severity and longevity of the eating disorder, as well as the recovery trajectory. People with ADHD and eating disorders have differences in how their brains process rewards, often looking for dopamine hits that can come from eating disorder behaviors. Disturbance in body awareness as an associated feature interferes with the ability to feel hunger/satiety cues and feelings. Difficulties with decision-making, planning, as well as time-blindness and difficulty with transitions, make it harder to meal plan and nourish oneself consistently throughout the day. People with ADHD often seek certain types of food making it more difficult to eat a wide variety of food. These are just some of the many nuances that show up with clients who have both an eating disorder and ADHD. 

The treatment for ADHD is very clear in the literature. We know that medication is incredibly helpful above and beyond therapy and behavioral modifications alone. As I mentioned before, it gets messy when someone also has an eating disorder as many ADHD medications are known to suppress appetite. But instead of concluding that medicating ADHD for someone who also has an eating disorder is contraindicated, we need to explore the nuances in this as well. 

While ADHD medication may compromise hunger cues, the medication may also help to overcome other barriers to recovery. For example, the client may be better able to strategize and execute on their meal plan as they suddenly have the brain capacity to do so. ADHD medication can relieve some of the symptoms that the eating disorder worked to mitigate, such as dysphoria, distress, feeling overstimulated and overwhelmed. Clients may be better able to tolerate the distress inherent in eating disorder recovery with the help of medications that can calm their minds. 

I am not “that kind of doctor” that can assert medication for clients. I am the kind of doctor who advocates for treating all the presenting concerns our clients face. And the more we understand about ADHD and its relationship to eating disorders, we understand the critical importance of treating both illnesses. If we only treat the eating disorder and neglect ADHD, our clients will likely struggle more on the path to recovery and in their ability to sustain it. Besides this, we would be neglecting ongoing and treatable pain that were treated, which would bring immense relief, increased confidence, self-awareness, and continued motivation. 

We have a lot more to learn and understand about ADHD and eating disorders. And what we do know so far, calls us in the field to look closely at the nuances these presentations bring to treatment, and how we need to be flexible, mindful, and deliberate in how we help treat our clients to optimize their success.

Attention Deficit Hyperactivity Disorder (ADHD) seems to be the diagnostic soup de jour. We all heard about the Adderall shortages that started in late 2022 and still aren’t fully resolved now in 2024. Everyone is talking about ADHD and more and more people are getting diagnosed with it. Diagnoses are especially escalating among adults, with rates of adult diagnosis increasing four times faster than diagnostic rates for children. 

A lot of people are skeptical about this rise in diagnosis. Are smartphones making everyone develop ADHD? Is it the plastics? Is it our stressful lifestyles and chronic inflammation? Are there really that many more people with ADHD today? Or have there always been this many people with ADHD and we are now better at catching it with increased awareness and access to resources? 

Just as rates of ADHD increase, our field is continuing to grow in its own understanding of this diagnosis. As it relates to my interest in women’s issues, we know that females have historically been underdiagnosed for ADHD given the nuances of its presentation in females and female’s ability to compensate and mask symptoms. 

ADHD also has a unique and messy history with its association to eating disorders. When I started working in the field of eating disorders over a decade ago, I was implicitly and explicitly taught to be skeptical of clients who self-ascribed as having ADHD in addition to an eating disorder. I was taught that 1. Malnourished and starved brains present in similar ways to people who have ADHD, and 2. Our clients are incentivized to claim themselves to have ADHD so they can be prescribed a stimulant that would curb their appetite and further their weight loss goals. I was taught that when clients are re-nourished, their “ADHD symptoms” would resolve, confirming the above assertions. Our clients would then understand that their experiences with ADHD symptoms were really just manifestations of their eating disorder and they would feel the relief that comes with a nourished brain and be incentivized to stay in recovery. 

Join me next week for Part 2 as we discuss more about ADHD and eating disorders.